In order to compare mechanical stability of the Ilizarov external fixation methods for treatment of pilon fracture of the tibia, six human amputed tibiae were utilized to simulate Ruedi type I, II, and III fractures anatomically and non-anatomically reduced. Six fracture models which were either anatomically(3) or non-anatomically(3) reduced were first stailized by the Ilizarov construct composed of two tibial rings and foot assembly with connecting rods and ankle hinges and underwent axial load compression test using Instron. And then same tests were repeated on the models in which ankle hinges between the tibial rings and foot assembly were removed to examine biomechanical effect of the ankle hinges on the fracture stability. When the fracture model was fixed by the construct without ankle hinges, 720 N-780 N were required to disrupt fracture stability. When the fracture was non-anatomically reduced and was fixed by the construct without ankle hinges, 420 N-520 N were required to disrupt the fracture stability. The current study suggests that Ilizarov fixation system should have the construct composed of two tibial rings and foot assembly with connection rods and ankle hinges to prevent fracture destabilization during early ankle motion and weight-bearing in the tibial pilon fracture.
Ankle ; Foot ; Humans ; Methods ; Tibia ; Weight-Bearing

BACKGROUND: The purpose of this study is to improve the quality of the diagnostic procedures in the preoperative evaluation so as to reduce the unnecessary thoracotomy and to ensure resectability in non-small cell lung cancer. MATERIAL AND METHOD: Of 616 patients who underwent thoracotomy for primary lung cancer from January 1990 to December 1996, 59 patients(9.6%) turned out to have inoperable lesions after the thoracotomy. We reprospectively reviewed the bronchoscopic findings, methods of tissue diagnosis, CT scans, pulmonary function test and lung perfusion scan, reasons for nonresectability, and adjuvant therapy, and then followed up on the survival rate after exploratory thoracotomy. RESULT: The cell types were squamous cell carcinoma in 38, adenocarcinoma in 15, large cell carcinoma in 3 and others in 3. Primary loci were RUL in 20, RML in 6, RLL in 8, LUL in 13, LLL in 4 and others in 8. The reasons for non-resectability were various; direct tumor invaison to mediastinal structures(n=41), seeding on pleural cavity(n=8), poor pulmonary function(n=2), invasions to extranodal mediastinal lymph node(n=2), technical non- resectability due to extensive chest wall invasion (n=3), small cell carcinoma (n=1), malignant lymphoma(n=1), and multiple rib metastases(n=1). In the follow-up of 58 patients, 1-year survival rate was 55.2% and 2-year survival rate was 17.2% and the mean survival time was 14 months. When compared according to cell types or postoperative adjuvant therapeutic modalities, no significant difference in the survival rates were found. The squamous cell carcinoma was frequently accompanied by local extension to contiguous structures and was the main cause of non-resectability. In adenocarcinoma, pleural seeding with malignant effusion was frequently encountered, and was the major reason for non-resectability. CONCLUSION: These data revealed that if appropriate preoperative diagnostic tools had been available, many unnecessary thoracotomies could have been avoided. Both the use of thoracoscopy in selected cases of adenocarcinoma and the more aggressive surgical approach to the locally advanced tumor could reduce the incidence of unnecessary thoracotomies for non-small cell lung cancers.
Adenocarcinoma ; Carcinoma, Large Cell ; Carcinoma, Non-Small-Cell Lung* ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Diagnosis ; Follow-Up Studies ; Humans ; Incidence ; Lung ; Lung Neoplasms ; Perfusion ; Respiratory Function Tests ; Ribs ; Survival Rate ; Thoracic Wall ; Thoracoscopy ; Thoracotomy* ; Tomography, X-Ray Computed

PURPOSE: The authors evaluated the clinical results and prognosis after amputating the lower extremity due to diabetic foot. MATERIALS AND METHODS:From 1991 to 2003, the patients who had suffered amputation of his lower extremity due to diabetic foot ulcer were evaluated retrospectively. 79 patients were male and 6 patients were female. The author evaluated the patient who had the ipsilateral additional surgery, contralateral amputation, level of blood sugar, combined disease and mortality rate within 5 years from medical record. Statistical analysis was done by Chi-square test and Kaplan-Meier survival test. RESULTS:Mean age of patients who had first experienced amputation was 63.4 years old. The mean duration of diabetes until amputation was 14.5+/-7.5 years. Major amputations were 50 cases and minor amputations 35 cases. 20 patients (23.5%) were suffered ipsilateral secondary surgery including revised stump. Overall 5-year mortality rate was 18.8% (16 cases). Death rate within 1 year was 8.2% (7 cases), mortality rate within 3 years was 14.1% (12 cases). 5-year mortality rate after major amputation was 20% (10 cases) and after minor amputation was 17.1% (6 cases). It was statistically significant (p<0.05). Patient who underwent more than 2 combined vascular related disease had higher mortality rate than diabetic amputee without combined disease (p<0.05). CONCLUSION: Mortality rate after major amputation was significant higher than amputation after minor amputation in diabetic patients from our data.
Amputation ; Amputees ; Blood Glucose ; Diabetic Foot ; Female ; Humans ; Lower Extremity ; Male ; Medical Records ; Prognosis ; Retrospective Studies ; Ulcer

This report documents a case of myeloid erythrophagocytosis in a patient with myeloproliferative disorder. The patient had pancytopenia and his marrow was hyperplastic with erythrophagocytosis by myeloid cells of various stages, including myeloblasts. He was diagnosed to have a prefibrotic stage of chronic idiopathic myelofibrosis. The erythrophagocytosis by myeloid cells persisted even after 2 months of treatment for the primary disorder.
Erythrocytes/*pathology ; Human ; Male ; Middle Aged ; Myeloid Cells/*pathology ; Myeloproliferative Disorders/*pathology ; Pancytopenia/pathology ; *Phagocytosis

This is a case report of an operation for the pulmonary arteriovenous fistula supplied from the systemic arteries instead of the pulmonary artery. The operation of systemic arteriovenous pulmonary fistula has formidable technical challenges due to its extensive collateral circulations. A 16 year-old female patient, diagnosed as systemic arteriovenous fistula with multiple tortuous feeding vessels and with hereditary hemorrhagic telangiectasia, was initially managed with arterial embolization before the operation. A 15x8cm sized huge vascular malformation was removed by RML and RLL bilobectomy. During the operation, we encountered annoying massive bleeding and pulmonary congestion originated in its extensive collateral circulation. The patient was discharged after conservative management without specific problem on the 15th postoperative day. For the safe operation as well as good operative result, it seemed that meticulous ligation of the multiple collateral vessels should be performed prior to that of pulmonary veins.
Adolescent ; Arteries ; Arteriovenous Fistula* ; Collateral Circulation ; Estrogens, Conjugated (USP) ; Female ; Fistula ; Hemorrhage ; Humans ; Ligation ; Pulmonary Artery ; Pulmonary Veins ; Telangiectasia, Hereditary Hemorrhagic ; Vascular Malformations

BACKGROUND: We evaluated early and long-term results after heart transplantation (HTPL). METHODS: One hundred five consecutive patients (male:female=80:25) who underwent HTPL between 1994 and 2013 were enrolled. Based on the changes in immunosuppressive regimen, the study patients were divided into two groups. Early and long-term clinical outcomes were evaluated and compared between the patients who underwent HTPL before (group E, n=41) and after July 2009 (group L, n=64). The group L patients were older (p<0.001), had higher incidence of hypertension (p=0.001) and chronic kidney disease (p<0.001), and more frequently needed preoperative mechanical ventilation (p=0.027) and mechanical circulatory support (p=0.014) than the group E patients. RESULTS: Overall operative mortality was 3.8%, and postoperative morbidities included acute kidney injury (n=31), respiratory complications (n=16), reoperation for bleeding (n=15) and wound complications (n=10). There were no significant differences in early results except acute kidney injury between group E and group L patients. Overall survival rates at 1, 5, and 10 years were 83.8%, 67.7%, and 54.9%, respectively, with no significant difference between the two patient groups. Rejection-free rates at 1 and 5 years were 63.0% and 59.7%, respectively; rates were significantly higher in group L than in group E (p<0.001). CONCLUSION: Despite increased preoperative comorbidities, group L patients showed similar early and long-term outcomes and significantly higher rejection-free rates when compared with group E patients.
Acute Kidney Injury ; Comorbidity ; Heart Transplantation* ; Heart* ; Hemorrhage ; Humans ; Hypertension ; Incidence ; Mortality ; Renal Insufficiency, Chronic ; Reoperation ; Respiration, Artificial ; Survival Rate ; Transplantation ; Wounds and Injuries

BACKGROUND AND OBJECTIVES: Although Gore-Tex is popularly used in nasal augmentation in human, studies about the histological changes have been carried out only in animal models. The purpose of this study is to investigate histological changes of Gore-Tex used in nasal augmentation in human. SUBJECTS AND METHODS: Gore-Tex of 24 patients who underwent nasal augmentation using Gore-Tex (non-reinforced sheets) 2-36 months ago and had re-operated for the sole cosmetic problems was obtained. Histologic examination was performed from specimens including Gore-Tex and the surrounding soft tissue with light microscope and electromicroscope. RESULTS: Histologically, connective tissue ingrowth was observed in all specimen. But the degree of foreign body reaction and collagen deposit varied from specimen to specimen and had no relationship with the duration. Neovascularization was observed from specimen whose duration was longer than 12 months and degenerative calcification was observed from 36 month old specimen. CONCLUSION: Unlike the findings of previous reports, individual differences and partial degenerative lesions in Gore-Tex were observed. Additional studies are required to confirm the stability of Gore-Tex as an implant to be used in human.
Child, Preschool ; Collagen ; Connective Tissue ; Foreign-Body Reaction ; Humans* ; Individuality ; Models, Animal ; Polytetrafluoroethylene ; Rhinoplasty

PURPOSE: Idiopathic scoliosis is a structural lateral curvature of the spine of unknown etiology. The relationship between degree of spine curvature and cardiopulmonary function has not yet been investigated. The purpose of this study was to determine the association between scoliosis and cardiopulmonary characteristics. METHODS: Ninety children who underwent preoperative pulmonary or cardiac evaluation at a single spine institution over 41 months were included. They were divided into the thoracic-dominant scoliosis (group A, n=78) and lumbar-dominant scoliosis (group B, n=12) groups. Scoliosis severity was evaluated using the Cobb method. In each group, relationships between Cobb angles and cardiopulmonary markers such as forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC, left ventricular ejection fraction, pulmonary artery flow velocity, and tissue Doppler velocities (E/E', E'/A') were analyzed by correlation analysis linear regression. RESULTS: In group A, 72 patients (92.3%) underwent pulmonary function tests (PFTs), and 41 (52.6%) underwent echocardiography. In group B, 9 patients (75.0%) underwent PFT and 8 (66.7%) underwent echocardiography. Cobb angles showed a significant negative correlation with FVC and FEV1 in group A (both P<0.05), but no such correlation in group B, and a significant negative correlation with mitral E/A ratio (P<0.05) and tissue Doppler E'/A' (P<0.05) in group A, with a positive correlation with mitral E/A ratio (P<0.05) in group B. CONCLUSION: Pulmonary and cardiac function was significantly correlated with the degree of scoliosis in patients with thoracic-dominant scoliosis. Myocardial diastolic function might be impaired in patients with the most severe scoliosis.
Child* ; Echocardiography ; Forced Expiratory Volume ; Humans ; Linear Models ; Pulmonary Artery ; Respiratory Function Tests ; Scoliosis* ; Spine ; Stroke Volume ; Vital Capacity

The causes of central diabetes insipidus (CDI) are numerous; some primary cases are idiopathic while most secondary cases are surgically induced or the result of tumor. The frequency of metastatic tumor as a cause of DI is 6% to 20% of cases, Variety of malignancies including breast, lung, colon, prostate cancer, and leukemia/lymphoma have been reported to metastasize to the pituitary, although most patients are asymptomatic. Clinical manifestations of pituitary metastases include anterior pituitary failure, visual disturbance, and extraocular muscle weakness. DI is the most common clinical manifestation of hypothalamic-pituitary axis (HPA) metastases. Anatomical basis far this clinical picture is that most metastases occur in the posterior lobe. We report on a 35-year-old male patient with meningeal involvement of malignant lymphoma that was thought to be associated with DI. Confirmation of primary malignancy was made by biopsy at site of cervical lymph node and tonsil, Pituitary involvement was suspected on brain MRI, and satisfactory symptornatic relief was obtained with vasopressin. Because of the progres-sion of underlying lymphorna that has shown no response to combined anticancer chemotherapy, the patient expired on 60th hospital day.
Adult ; Axis, Cervical Vertebra ; Biopsy ; Brain ; Breast ; Colon ; Diabetes Insipidus, Neurogenic* ; Drug Therapy ; Humans ; Lung ; Lymph Nodes ; Lymphoma* ; Magnetic Resonance Imaging ; Male ; Muscle Weakness ; Neoplasm Metastasis ; Palatine Tonsil ; Prostatic Neoplasms ; Vasopressins

PURPOSE: To differentiate multiple myeloma and metastasis of the spine. MATERIALS AND METHODS: Retrospectiveanalysis of MR images of the patients with multifocal spinal involvement of multiple myeloma and metastasis wasdone. Analysis was done in viw points of bone marrow involvement pattern(focal, diffuse, and mixed), margin,number, size and uniformity of the focal lesions, involvement of pedicle and posterior element, and epidural andparavertebral mass formation. RESULTS: Multiple myeloma predominantly showed diffuse pattern (11/21, 52.4%) ofmarrow involvement, while metastasis showed mainly focal pattern (18/21, 85.7%). Margin of the focal lesions weredistinct in majority (8/10, 80%) of multiple myeloma and indistinct in majority (16/21, 76.2%) of metastasis. Sizeof the focal lesions were smaller in cases of multiple myeloma than those of metastasis, but number and standarddeviation of the size of the focal lesions did not show significant difference between the two diseases.Involvement of posterior element were more common in multiple myeloma, and epidural mass formation andparavertebral mass formation were more common in metastasis. CONCLUSION: The diffuse pattern of marrow involvementalone suggests multiple myeloma. When a focal or a mixed pattern is found, distinct margin and smaller focallesions are suggestive of multiple myeloma, and indistinct margin and larger focal lesions andepidural/paravertebral mass formation are suggestive of metastasis.
Bone Marrow* ; Humans ; Multiple Myeloma* ; Neoplasm Metastasis* ; Spine*